2015-200 41111a. TOWN OF QUEENSBURY
Forg742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150200 Date Issued: Thursday, June 04, 2015
This is to certify that work requested to be done as shown by Permit Number P20150200
has been completed.
Tax Map Number: 523400-315-005-0001-002-000-0000
Location: 43 WEST MT. Rd
Owner: MICHAEL & MICHELLE BARBONE
Applicant: MICHAEL & MICHELLE BARBONE
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the 4714
property owner of the responsibility for compliance with Site Plan, �,Yf
Variance, or other issues and conditions as a result of approvals by the Director of Building&Co e Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
0^,
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
I OS I
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150200 Application Number: A20150200
Tax Map No: 523400-315-005-0001-002-000-0000
Permission is hereby granted to: MICHAEL& MICHELLE BARBONE
For property located at: 43 WEST MT. Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: MICHAEL& MICHELLE BARBONI Septic Alteration Residential
43 WEST MT. Rd Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY.NY 12804
Plans&Specifications
BP 2015-200
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, May 27,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tow ueensb ; d fr.sd. , May 27, 2015
i
SIGNED BY 41 for the Town of Queensbury.
Director of Building&Code Enforcement
s�F?. 'Y3.,ty eve!o- nt Office
DI ,Town of Queensbury ti,1 • Bay Road a Queensbury, New York =128041
r.., ,
Office Use OnlyMAY 2 6 ZUV3
TAX MAP NO. 1' ' •iU�Fh1SBUF''' PERMIT NO. ���'` PERMIT FEE
APPROVALS: ZONING ^ ? ''ODFTOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: I ( \ \� yi
;/'�o Y1� INSTAL I FR: ISJ 5 € p t I C
ADDRESS: 3 \N ,S V` . fkd' ADDRESS: \O w l W U i r 1 S j`
PHONE NOS. b \ —L \ C PHONENOS. 7 9 ,
3 `��/
LOCATION OF INSTALLATION: Li e J P�� c,. `
RESIDENCE INFORMATION:
YEAR BUILT
NO.OF X I COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRI[ FR
�1D
1980 or older X 150 = 1 41 (j INSTALLED? NN
1981-1991 I V� X — 130 = I V N SPA OR HOT TUB
11992-present 'v I ` X 110 v Lk- INSTALLED? it( ('`
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT RO ING \ STEEP SLOPE
Nle %SLOPE \V
✓ SOIL NATURE: SAND J LOAM CLAY „' OTHER \V 11—
✓ GROUNDWATER N AT WHAT DEPTH? N \q
r
✓ BEDROCK/IMPERVIOUS MATERIAL: AT W7i-
v
DEPTH?I\�"J(!!!\liV
DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
'� J l•
' ✓ PERCOLATION TEST: RATE IS V PER MIINUTE PER INCH[mpij (Test to be completed by a licensed professional
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: ICI eiC) GALLON (MIN.SIZE IS 1.000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirl of tub.
SYSTEM PE: �--{�
SORPTION FIELD(WITH NO.2 STONE) Total length-).--00 ft_ Each trench I x 5 `+J
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? V Size? l V h.
o ALTERNATIVE SYSTEM Bed or other type? �(
❑ HOLDING TANK SYSTEM Total required capacity? NTank size? \\I \--\\ Number of tanks? \`I l�
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY_ PLEASE REVIEW LIST PROVIDED.
For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval
granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant,shall be void.
I have read the regulations with respect to this application and agree to /// 1'
abide by these .••. - requirements of the Town of Queensbu (QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Se ; • •••osal Ordinance. ���/ 1 coclesna cueensburv.nee
Signa on Responsible Date 9� I VISIT OUR WEBSITE FOR MORE INFORMATION
Jwi.Rftr.oueensburv.:Ka
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256 1
Septic Inspection Report
Inspection request received: 5'211 1�
Name: 1 :llbpycj Inspected on: '(n, \ 1`J
Location: ,zt m- • 1La• Arrive: a.m./p.m.
Permit No.: 15-Zoo Inspector's Initials:
--4 Comments and/or diagram
1 Soil Type:644Lo lay
Type of Water: unicipal ell Water
Waterline separation istance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length j,ai ft.
Length of each trench !ate ft.
Depth of trenches 2 ft.
Size of Stone e
Seepage Pits: Number 0/✓A-
Size: x
Stone Size:
Piping Size Type
Ai
Building to tank `s 1
Tank to Distribution Box . -SliR, 35"
Distribution Box to Field/Pit 4Alit.k
STIR- 3 ç' 4-
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes&Baffles Vr_N
Manholes 12"or less below grade Y
[provide extension collar if Yes] Y III Pt
Location/Separations
Foundation to tank 10 ft.
Foundation to absorption 2£5-6 ft.
Separation of Pits PIA- ft.
Conforms as per Plot Plan / N,,
Engineer Report and As-Built Y
ETU Maintenance Contract provided Y N
Location of Systerrri'Pr perty:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Stat,_
//.prove.
Pa ial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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